Neurologic System The Motor System and the Cerebellar

Neurologic System The Motor System and the Cerebellar Function

Motor Pathways & Type of Movements • Corticospinal or Pyramidal Tract – Voluntary, skilled, discrete, purposeful (writing) • Extrapyramidal Tracts – Maintain muscle tone and control body movements (walking) • Cerebellar System – Coordinates movement, maintains equilibrium and posture…. Operates on subconsious level

Question for Thought • Describe 3 major motor pathways in the CNS including the type of movements mediated by each?

Chapter 21 • Cerebral Cortex Figure 21 -1. p. 688.

Upper and Lower Motor Neurons • Upper motor neurons • All descending motor neurons that impact on the lower motor neurons • Located in the CNS • Convey impulses from motor areas of cerebral cortex to lower motor neurons in the cord • Diseases = CVA, Cerebral palsy, Multiple sclerosis

Upper and Lower Motor Neurons • Lower motor neurons • In the peripheral nervous system • 12 cranial nerves • 31 pairs of spinal nerves and all branches • • • Final direct contact with the muscles Movement translated into action Reflex arc Examples = cranial nerves, spinal nerves Diseases = spinal cord lesions, poliomyelitis, ALS

Question for Thought • Differentiate an upper motor neuron from a lower motor neuron?

Subjective Data • In the Interview – Any shakes or tremors in the hands or face? • Worsen with anxiety, fatigue • Relieved with activity, alcohol • ADL’s affected – Weakness • Where? When? Why?

Subjective Data • Incoordination • Balance, falling, • Legs give out • Clumsy • Numbness/ Tingling • Describe ( pins and needles) • Significant past history • TIA’s, Atrial Fib.

Assessment of Motor System • • • Body position Involuntary movements Muscle size ( bulk) Muscle tone Muscle strength

Body Position • Observe during movement • Observe at rest

Involuntary Movements • Tremors, tics, fasciculations, myoclonus • Note: • • • Location Quality Rate Rhythm Amplitude

Involuntary Movements • Note the involuntary movement in relation to : • • • Posture Activity Fatigue Emotion Other factors

Terms to Describe Movement • • • Flexion Extension Abduction Adduction Pronation Supination

More Terms for Movement • • • Circumduction Inversion Eversion Rotation Protraction

Terms of Movement Continued • Retraction • Elevation • Depression

Muscle Size • Compare size and contour – Atrophy • Unilateral/bilateral • Proximal/distal

Muscle Tone • A relaxed muscle maintains a slight residual tension referred to as muscle tone. • Hypo tonic, Flaccidity. • Spasticity. • Lead-pipe rigidity.

Muscle Strength • Test muscle strength by asking the client to move actively against your resistance or to resist your movement. • A muscle is strongest when shortest and weakest when longest.

Terms to Describe Strength • • • Weakness (paresis) Paralysis (plegia) Hemiparesis Hemiplegia Paraplegia Quadriplegia

Grading Muscle Strength • • Scale 0 -5 0 - no muscular contraction 1 – slight contraction 2 – Full ROM, gravity eliminated

Grading Muscle Strength • 3 – Full ROM against gravity • 4 – Full ROM against gravity, some resistance • 5 – Full ROM against gravity full resistance without evident fatigue = Normal Muscle Strength

Cerebellar Function • Balance tests – Gait • • Observe normal walk Tandem Walking ( heel – to- toe ) Romberg Test (stand, feet together, arms at side, close eyes) Shallow knee bend or hop on one leg • What findings would you expect to see when assessing gait and balance in an older adult?

Cerebellar Function • Coordination and Skilled Movements – RAM ( Rapid alternating movements) • • • Pat Knees Thumb to each finger Finger to nose Heel to shin

Question for Thought • List and describe 3 tests of cerebellar function?

Charting Sample • For Normal Muscle Strength (objective) – Able to maintain flexion against resistance and without tenderness • For Motor ( objective) – No atrophy, weakness or tremors. Gait smooth and coordinated, able to tandem walk, negative Romberg. RAM, finger-to-nose smoothly intact